J Clin Outcomes Manage
Improving secondary prevention of cardiovascular disease through increased referral to cardiac rehabilitation
Abstract Objective: To review and summarize the evidence on factors predicting referral and strategies for improving referral to cardiac rehabilitation (CR). Methods: All published systematic reviews relating to referral to CR were first retrieved. Recently published individual papers (2004–2006) were then sought through MEDLINE, CINAHL, and EMBASE using the search terms “cardiac rehabilitation” and “secondary prevention” combined with “referral,” “physician endorsement,” “automatic referral,” and “referral bias.” Results: Determinants of referral to CR are described according to 3 clusters: sociodemographic determinants, patient health status determinants, and health care system determinants. Strategies that have been shown to improve referral are primarily related to health care system determinants, particularly automatic referral mechanisms and physician endorsement. Conclusion: CR is underutilized due to overall suboptimal referral of eligible patients and inequities among those who are referred. Automatic processes that have received the a priori endorsement of physicians would lead to reducing the treatment gap in CR and secondary prevention of cardiovascular disease.
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